This procedure is ideally suited to patients with a combination of brow ptosis, excessive forehead skin and soft tissue and a low non-receding hairline.
A bevelled high coronal incision is made within the hairline following the shape of the latter far enough posterior to position the subsequent scar 3-4cm posterior to the anterior hairline. The incision is angled to run parallel with the axis of the hair follicles down to periosteum. A forehead scalp flap is elevated using predominantly blunt dissection in the loose sub-galeal plane above the periosteum to within 2cm of the supraorbital rim centrally. Careful lateral dissection is undertaken avoiding seventh nerve branch damage.This is continued along the supraorbital rim with selective weakening surgery to the corrugator procerus and frontalis muscles avoiding damage to the supraorbital neurovascular bundles. A supraorbital periosteal incision may further enhance the procedure. Meticulous haemostasis throughout is essential before excision of excess flap tissue within the hairline.The wound is carefully closed in layers using deep 3/0 Vicryl and surgical staples or 4/0 Prolene, after placement of a supraorbital drain.The staples or sutures are removed seven to ten days post operatively.
Post operative haematoma leading to flap necrosis, localised sensory and motor nerve damage, hair loss and unacceptable scarring are all recognised complications, the majority of which can be avoided with careful surgical technique.
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